한국간담췌외과학회지 (Annals of Hepato-Biliary-Pancreatic Surgery)

  • 제14권1호
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  • Pages.37-45
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  • 2010
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  • 2508-5778(pISSN)
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  • 2508-5859(eISSN)
한국간담췌외과학회 (The Korean Association of Hepato-Biliary-Pancreatic Surgery)
권호 표지

간내결석증의 최근 치료경험 및 장기 치료성적 분석

Recent Treatment Modalities for Hepatolithiasis and Long-term Outcomes

  • 임창섭 (서울대학교 의과대학 외과학교실) ;
  • 장진영 (서울대학교 의과대학 외과학교실) ;
  • 이승은 (서울대학교 의과대학 외과학교실) ;
  • 강미주 (서울대학교 의과대학 외과학교실) ;
  • 김선회 (서울대학교 의과대학 외과학교실)
  • Lim, Chang-Sup (Department of Surgery, Seoul National University College of Medicine) ;
  • Jang, Jin-Young (Department of Surgery, Seoul National University College of Medicine) ;
  • Lee, Seung-Eun (Department of Surgery, Seoul National University College of Medicine) ;
  • Kang, Mee-Joo (Department of Surgery, Seoul National University College of Medicine) ;
  • Kim, Sun-Whe (Department of Surgery, Seoul National University College of Medicine)
  • 발행 : 2010.03.30
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: Treatment of hepatolithiasis is difficult because of the high recurrence rate, and the long-term outcome is not satisfactory. We reviewed clinical outcomes to determine the optimal treatment modalities for hepatolithiasis. Methods: Between 1981 and 2005, 648 patients with hepatolithiasis were treated at our institute. Changing patterns of treatment modalities and outcomes were analyzed for the periods: $1^{st}$ (1981~1985; n=159), $2^{nd}$ (1986~1990; n=100), $3^{rd}$ (1991~1995; n=111), $4^{th}$ (1996~2000; n=141), and $5^{th}$ (2001~2005; n=137). Clearance and recurrence rates according to the treatment modalities and associated malignancies were analyzed in patients for the most recent 10 years. Results: During the past 25 years, hepatectomy as a treatment for hepatholithiasis has increased in frequency and become the major treatment modality in the recent 10 years, while choledocholithotomy and drainage procedures have decreased in frequency. With improvement in operative clearance and post-operative lithotripsy, the final clearance rate improved from 79.0% to 91.3%. In the most recent 10 years, the final clearance rate of hepatectomy, choledocholithotomy, cholangioenterostomy, and PTCS was 97.1%, 82.0%, 78.8%, and 100%, respectively, and the recurrence rate was 34.7%, 15.4%, 17.0%, and 42.9%, respectively. Twenty-six patients (47.2%) had recurrences within 2 years, and 12 patients (21.8%) had recurrences after 5 years. Cholangiocarcinomas occurred in 10 patients (3.6%). The diagnosis of cholangiocarcinoma was established pre-operatively in 2 patients, post-operatively in 4 patients, and during the follow-up period in 4 patients. Conclusion: In the treatment of hepatolithiasis, hepatectomy has a high clearance rate and a low recurrence rate. To reduce the recurrence rate, complete stone clearance without residual stones seems to be of utmost importance. Suspicion of malignancy and long-term follow-up are needed in the management of patients with hepatolithiasis.

키워드

참고문헌

  1. Mori T, Sugiyama M, Atomi Y. Gallstone disease: management of intrahepatic stones. Best Pract Res Clin Gastroenterol 2006;20:1117-1137. https://doi.org/10.1016/j.bpg.2006.05.010
  2. Park YH, Park SJ, Jang JY, et al. Changing patterns of gallstone disease in Korea. World J Surg 2004;28:206-210. https://doi.org/10.1007/s00268-003-6879-x
  3. Su CH, Lui WY, P'Eng FK. Relative prevalence of gallstone diseases in Taiwan. A nationwide cooperative study. Dig Dis Sci 1992;37:764-768. https://doi.org/10.1007/BF01296436
  4. Chen XG, Liu JQ, Peng MH, et al. Clinical epidemiological study on intrahepatic cholelithiasis: analysis of 8585 cases. Hepatobiliary Pancreat Dis Int 2003;2:281-284.
  5. Lim CS, Jang JY, Kim SW. Experience with surgical treatments for hepatolithiasis. Korean J Hepatobiliary Pancreat Surg 2008;12:24-33.
  6. Kim SW, Suh KS, Park YH. Results of operations for the patients with hepatolithiasis. J Korean Surg Soc 1988;35: 388-395.
  7. Chen DW, Tung-Ping Poon R, Liu CL, Fan ST, Wong J. Immediate and long-term outcomes of hepatectomy for hepatolithiasis. Surgery 2004;135:386-393. https://doi.org/10.1016/j.surg.2003.09.007
  8. Yu CS, Kim SW, Park YH, Han JK. Cholangiographic features in hepatolithiasis. Korean J Gastroenterol 1993;25:140-150.
  9. Kim SW, Park YH. Surgical management of hepatolithiasis. Korean J Hepatobiliary Pancreat Surg 1997;1:25-31.
  10. Cheung MT, Kwok PC. Liver resection for intrahepatic stones. Arch Surg 2005;140:993-997. https://doi.org/10.1001/archsurg.140.10.993
  11. Ha TK, Choi CS, Choi YK, Paik NW. Hepatic resection for right-sided intrahepatic stones. Korean J Hepatobiliary Pancreat Surg 2005;9:31-35.
  12. Li SQ, Liang LJ, Peng BG, Lai JM, Lu MD, Li DM. Hepaticojejunostomy for hepatolithiasis: a critical appraisal. World J Gastroenterol 2006;12:4170-4174. https://doi.org/10.3748/wjg.v12.i26.4170
  13. Uchiyama K, Kawai M, Ueno M, Ozawa S, Tani M, Yamaue H. Reducing residual and recurrent stones by hepatectomy for hepatolithiasis. J Gastrointest Surg 2007;11:626-630. https://doi.org/10.1007/s11605-006-0024-8
  14. Kim SW, Lee KY, Han SW, Kwon OJ, Park YH. Clinical significance of choledochoscopy for the management of residual stone. J Korean Surg Soc 1996;50:999-1003.
  15. Akiyama T, Nagakawa T, Kayahara M, et al. Recurrence of intrahepatic stones after an end-to-side choledochojejunostomy. Surg Today 1994;24:599-605. https://doi.org/10.1007/BF01833723
  16. Lee TY, Chen YL, Chang HC, Chan CP, Kuo SJ. Outcomes of hepatectomy for hepatolithiasis. World J Surg 2007;31: 479-482. https://doi.org/10.1007/s00268-006-0441-6
  17. Otani K, Shimizu S, Chijiiwa K, et al. Comparison of treatments for hepatolithiasis: hepatic resection versus cholangioscopic lithotomy. J Am Coll Surg 1999;189:177-182. https://doi.org/10.1016/S1072-7515(99)00109-X
  18. Kim WW, Oh SH, Choi YK. Hepatic resection for intrahepatic stones. J Korean Surg Soc 1997;53:833-838.
  19. Song CY, Lee KS, Jung JH, et al. Hepatic resection for intrahepatic stones. J Korean Surg Soc 1997;52:552-558.
  20. Hwang S, Lee SG, Lee YJ, et al. Right hepatic lobectomy in the treatment of right-sided hepatolithiasis. J Korean Surg Soc 1999;57:550-557.
  21. Kim YH, Kang KJ, Lim TJ. Feasibility of left hemihepatectomy for the treatment of left intrahepatic duct stones. Korean J Hepatobiliary Pancreat Surg 2005;9:78-83.
  22. Lee SE, Jang JY, Lee JM, Kim SW. Selection of appropriate liver resection in left hepatolithiasis based on anatomic and clinical study. World J Surg 2008;32:413-418. https://doi.org/10.1007/s00268-007-9355-1
  23. Chen C, Huang M, Yang J, et al. Reappraisal of percutaneous transhepatic cholangioscopic lithotomy for primary hepatolithiasis. Surg Endosc 2005;19:505-509. https://doi.org/10.1007/s00464-004-8125-5
  24. Yeh YH, Huang MH, Yang JC, Mo LR, Lin J, Yueh SK. Percutaneous trans-hepatic cholangioscopy and lithotripsy in the treatment of intrahepatic stones: a study with 5 year follow-up. Gastrointest Endosc 1995;42:13-18. https://doi.org/10.1016/S0016-5107(95)70236-9
  25. Jan YY, Chen MF. Percutaneous trans-hepatic cholangioscopic lithotomy for hepatolithiasis: long-term results. Gastrointest Endosc 1995;42:1-5. https://doi.org/10.1016/S0016-5107(95)70234-2
  26. Jan YY, Chen MF, Hung CF. Balloon dilatation of intrahepatic duct and biliary-enteric anastomosis strictures. Long term results. Int Surg 1994;79:103-105.
  27. Falchuk KR, Lesser PB, Galdabini JJ, Isselbacher KJ. Cholangiocarcinoma as related to chronic intrahepatic cholangitis and hepatolithiasis. Case report and review of the literature. Am J Gastroenterol 1976;66:57-61.
  28. Koga A, Ichimiya H, Yamaguchi K, Miyazaki K, Nakayama F. Hepatolithiasis associated with cholangiocarcinoma. Possible etiologic significance. Cancer 1985;55:2826-2829. https://doi.org/10.1002/1097-0142(19850615)55:12<2826::AID-CNCR2820551219>3.0.CO;2-1
  29. Liu CL, Fan ST, Wong J. Primary Biliary Stones: diagnosis and Management. World J Surg 1998;22:1162-1166. https://doi.org/10.1007/s002689900536